2,4-Diaminoquinazoline analogs of folate were assessed as antileishmanial agents and as dihydrofolate reductase inhibitors. Against Leishmania major in human macrophages in vitro, two compounds with tertiary amines attached directly to the quinazoline ring were remarkably active. The 50% effective doses were in the picogram per milliliter range (12 to 91 pg/ml), and the in vitro therapeutic indices were -105. These compounds were 1,000 times more active on an absolute basis and had a 100 times more favorable therapeutic index than any compound previously tested in this model. Antileishmanial activity was not correlated with activity against Leishmania mexicana promastigote reductase, which suggests that folate utilization in general, rather than reductase activity specifically, was being inhibited.Tetrahydrofolate (THF) is an important cellular cofactor that acts as an acceptor and donor of 1-carbon fragments. For example, serine hydroxymethyl transferase removes a methyl group from serine, creating glycine, and forms N5,N10-methylene THF from THF. After conversion of N5,N10-methylene THF to N5-methyl THF by methylene THF reductase, N5-methyl THF is utilized by methionine synthetase, through which homocysteine is methylated to methionine and THF is regenerated. N5,N1O-THF also is a cofactor in the formation of thymidylate from deoxyuridylate by thymidylate synthetase. In this reaction, however, the cofactor donates both a 1-carbon group and hydrogen and is oxidized to dihydrofolate in the process. The ability of the cell to continue to synthesize thymidylate and DNA requires rereduction of dihydrofolate to THF by dihydrofolate reductase (DHFR). Structural analogs of THF such as methotrexate, trimethoprim, trimetrexate, and pyrimethamine and cycloguanil specifically inhibit DHFRs of tumor cells, bacteria, Pneumocystis species, and plasmodia, respectively, and are widely used clinical agents.Leishmania species and some other parasitic protozoa contain a bifunctional polypeptide possessing the enzymatic activity of both thymidylate synthetase and DHFR, in contradistinction to mammalian cells, in which the enzyme activities reside on separate polypeptides (12). Since DHFR is a target for rational chemotherapy and is structurally distinct in Leishmania species, intense work on its detailed structure is now being pursued. Thus, Grumont and coworkers (10, 11) have cloned, expressed, and compared the Leishmania major enzyme with that of monofunctional enzymes with the aim of rational design of a specifically antileishmanial agent. In addition, the activity of standard DHFR inhibitors against Leishmania amastigotes (mammalian forms) in murine macrophages (13), of novel 2,4-diaminopyrimidines or triazines against promastigotes (insect vector forms) (5, 16), and of novel 5-(substituted benzyl)-2,4-diaminopyrimidines against promastigotes and amastigotes in mouse peritoneal macrophages (17) is being investigated in the hope that agents devised for other diseases might have significant antileishmanial activity.We determined ...